UNDERGRADUATE ACADEMIC ETHICS BOARD Charge of Academic Misconduct/Request for Hearing INFORMATION: This form serves as an official charge of academic misconduct for use by the Undergraduate Academic Ethics Board of the Johns Hopkins University. Submission of this form assumes that you wish this case to be resolved by an Ethics Board panel. INSTRUCTIONS: Please complete all the following information to the best of your knowledge. Include copies of any relevant documents. It is advisable that you retain copies of this and all documents relevant to this case. Any questions may be directed to Tamara M. Saunders, Associate Dean for Student Conduct, Mattin Center, Suite 210, 410.516.8208 or via email to integrity@jhu.edu. Please type or print legibly. 1. Name, title, and campus phone number of faculty member bringing charges: 2. Name(s) of student(s) accused of academic misconduct: 3. List the course name, number, and section (if applicable) in which the misconduct occurred. List also the semester in which the course was taught. 4. Indicate the academic exercise(s) associated with the academic misconduct (i.e., Examination 3, second paper, etc.). 5. Indicate specifically the type of offense which occurred. If more than one student is involved, list each individually. (ex: John Doe-cheated on closed book exam by using crib notes) 6. Please describe the circumstances of the academic misconduct. Include all relevant information, as well as information you believe may be helpful to the Ethics Board. Use the reverse side of this sheet if necessary. 7. Please sign below indicating that all information is accurate to the best of your knowledge: __________________________ ______________________ __________ Faculty member signature Print name Date